Healthcare Provider Details

I. General information

NPI: 1306498068
Provider Name (Legal Business Name): TYLER S WARBRITTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3493 VETERANS DR N STE C
HUNTINGDON TN
38344-6230
US

IV. Provider business mailing address

3493 VETERANS DR N STE C
HUNTINGDON TN
38344-6230
US

V. Phone/Fax

Practice location:
  • Phone: 731-986-2933
  • Fax: 731-986-2938
Mailing address:
  • Phone: 731-986-2933
  • Fax: 731-986-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3905
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3905
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: